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Erdheim-Chester disease (ECD) is a rare non-Langerhans cell histiocytosis that frequently infiltrates the peri-kidney space ("hairy kidney" appearance), kidney pelvis and proximal ureters, leading to obstructive uropathy. Here, we analyzed the clinical characteristics, imaging findings and long-term kidney outcome of a large multicenter cohort comprising 195 consecutive patients with ECD. Retroperitoneal peri-kidney or peri-ureteral involvement was detected at diagnosis in 147 patients. Of them, 70 had hydronephrosis (bilateral in 47), and 16 with kidney atrophy (unilateral in 14). Kidney vascular peduncle infiltration was found in 60 patients, and kidney artery stenosis in 31. The estimated glomerular filtration rate (eGFR) at diagnosis was significantly lower in patients with than in those without peri-kidney involvement (median 74 vs. 98 mL/min/1.73 m

O presente estudo analisou a sub-bacia do Rio Km 119 no município de Campo Mourão, Estado do Paraná – PR. Foi levantado problemas existentes na área de estudo e fez-se os cálculos das características físicas (morfometria). Analisou-se as proporções do uso do solo e conflitos na sub-bacia que devem ser recuperados levando em conta a legislação ambiental. Aplicou-se o EUPS com auxílio das técnicas de geoprocessamento e por fim realizou-se prognóstico dos problemas e foi proposto soluções. Na literatura foi discutido vários problemas como o aumento da população urbana que acarretou em poluição antrópica e a consequente contaminação na sub-bacia do Rio Km 119 bem como a erosão do solo, a degradação da vegetação ciliar e a ocupação de Área de Preservação Permanente (APP), causando impactos ambientais no local de estudo. Os resultados encontrados permitiram observar os conflitos de uso do solo e a falta de planejamento urbano é um dos problemas que agravam a degradação dos recursos naturais em todo percurso da área de estudo. A agricultura e urbanização vem se expandindo em direção ao rio, diminuindo assim a área de vegetação presente no entorno do corpo hídrico. Uma das alternativas para gerenciar esse conflito é a criação de Unidades de Conservação para promover a fiscalização e monitoramento de forma a buscar o equilíbrio do ecossistema com sustentabilidade.

Introdução: O estágio vem se mostrando cada vez mais importante para a formação do acadêmico de medicina e a consolidação do seu conhecimento, bem como oportunidade de experiências valiosas para o aprendizado prático. Assim, vivências proporcionadas por estágios voluntários contribuem para a formação de habilidades necessárias de um médico generalista, com capacidade de resolutividade, reflexão e integração do conhecimento. Objetivo: Relatar a experiência de um estágio voluntário em otorrinolaringologia e a sua importância para a formação do estudante de medicina como generalista. Relato de experiência: O relato conta com experiências vividas por um discente no estágio obrigatório e optativo durante o período de 18 de fevereiro de 2019 a 08 de abril de 2019, com carga horaria de 40 horas semanais, pelo Instituto de Otorrino Dr. Aureo C. Cangussu, na cidade de Imperatriz-MA. O estágio optativo é um elo entre o mercado de trabalho e a rotina estudantil, como uma forma de apresentação do estudante a sua rotina profissional. Assim, é permitido desfrutar de diversas áreas de aprendizagem, bem como acompanhar a rotina ambulatorial e ainda do centro cirúrgico, aumentando assim a possibilidade de novas experiências. Conclusão: Nesse sentido, conclui-se que o estágio traz ao acadêmico de medicina grandes possibilidades referentes a aplicabilidade do conteúdo teórico aprendido durante a sua formação nas atividades que são propostas durante esse período, além de permitir uma formação generalista com maior qualidade devido as experiências que são desenvolvidas no estágio.

Background: Long-term sequelae, called Long-COVID (LC), may occur after SARS-CoV-2 infection, with unexplained dyspnoea as the most common symptom. The breathing pattern (BP) analysis, by means of the ratio of the inspiratory time (TI) during the tidal volume (VT) to the total breath duration (TI/TTOT) and by the VT/TI ratio, could further elucidate the underlying mechanisms of the unexplained dyspnoea in LC patients. Therefore, we analysed TI/TTOT and VT/TI at rest and during maximal exercise in LC patients with unexplained dyspnoea, compared to a control group. Methods: In this cross-sectional study, we enrolled LC patients with normal spirometry, who were required to perform a cardio-pulmonary exercise test (CPET) for unexplained dyspnoea, lasting at least 3 months after SARS-CoV-2 infection. As a control group, we recruited healthy age and sex-matched subjects (HS). All subjects performed spirometry and CPET, according to standardized procedures. Results: We found that 42 LC patients (23 females) had lower maximal exercise capacity, both in terms of maximal O2 uptake (VO2peak) and workload, compared to 40 HS (22 females) (p < 0.05). LC patients also showed significantly higher values of TI/TTOT at rest and at peak, and lower values in VT/TI at peak (p < 0.05). In LC patients, values of TI/TTOT at peak were significantly related to ∆PETCO2, i.e., the end-tidal pressure of CO2 at peak minus the one at rest (p < 0.05). When LC patients were categorized by the TI/TTOT 0.38 cut-off value, patients with TI/TTOT > 0.38 showed lower values in VO2peak and maximal workload, and greater values in the ventilation/CO2 linear relationship slope than patients with TI/TTOT ≤ 0.38 (p < 0.05). Conclusions: Our findings show that LC patients with unexplained dyspnoea have resting and exertional BP more prone to diaphragmatic fatigue, and less effective than controls. Pulmonary rehabilitation might be useful to revert this unpleasant condition.

In ST-elevation myocardial infarction (STEMI) patients undergoing primary percutaneous coronary angioplasty (PPCI) the index of microcirculatory resistance (IMR) correlates to the extent of myocardial damage and left ventricular (LV) function recovery. Data on the IMR time-course and impact on clinical outcome in STEMI patients with multi-vessel disease (MVD) are scarce.We designed a prospective, multicenter clinical trial to assess the infarct-related artery (IRA)-IMR in STEMI patients with MVD undergoing PPCI and to explore its potential in relationship with outcome and LV remodeling.The study enrolled 242 STEMI patients with MVD. Both fractional flow reserve (FFR) and IMR of the IRA were assessed after successful PPCI. Then, FFR/IMR measurements were repeated in the IRA at a staged angiography, and FFR-guided angioplasty was performed in non-IRA lesions. The primary endpoint was the composite of cardiovascular death, re-infarction, re-hospitalization for heart failure, resuscitation or appropriate ICD shock at 1-year follow-up.A significant improvement of IRA-IMR values (from 47.9 to 34.2,After successful PPCI, a significant proportion of patients with STEMI and MVD had coronary microvascular dysfunction as assessed by IMR that recovered early after reperfusion. Higher IMR values predicted lack of improvement of LV function only in anterior STEMI.https://clinicaltrials.gov/, identifier [NCT02325973].

O presente estudo teve por objetivo realizar um diagnóstico do Comitê da Bacia do Rio Passo Fundo no Estado do Rio Grande do Sul – RS, no que tange a questões administrativas e quanto ao atendimento dos instrumentos da Política Nacional de Recursos Hídricos (PNRH), sob a luz da Lei 9.433/97 (BRASIL, 1997). Para realizar o diagnóstico foram utilizados dados secundários disponíveis no website do próprio comitê, bem como em cadernos de capacitação da Agência Nacional de Águas e Saneamento Básico. Também utilizou-se um checklist, subdividido em dois blocos: o primeiro abordou a estrutura administrativa do CBH e o segundo teve foco no plano de bacia hidrográfica do rio Passo Fundo. Os principais resultados do diagnóstico apontaram que o enquadramento foi homologado pelo Conselho Nacional de Recursos Hídricos em 2013 e delimita suas águas superficiais nas classes 1 e 2, ou seja, de qualidade considerada satisfatória na maior parte da bacia. O sistema de informações da referida bacia tem como base principal de divulgação de dados sua website. No CBH do Rio Passo Fundo, os critérios e normas referentes à outorga são de competência do Conselho de Recursos Hídricos. No que concerne à cobrança pelo uso da água, pode-se afirmar que a mesma não foi aprovada e implementada pelo referido comitê. Com relação ao Plano de Bacia, pode-se afirmar que o mesmo foi aprovado pelo CBH, todavia não foram encontradas medidas de gestão para cumprir as metas definidas no referido documento.

Al brindar una revisión breve y no autorizada de las relaciones físicas y culturales entre las áreas rural/forestal y urbana en la Amazonía, identificamos varios aspectos a mejorar, como subsidiar la residencia de largo plazo de los profesionales de la salud en el campo, implementar cinturones agrícolas/extractivistas peri-urbanos para la seguridad alimentaria en las ciudades, aumentar la penetración de los bosques y espacios verdes en los paisajes urbanos amazónicos, invertir en innovación en torno al concepto de “ciudades inteligentes-bosques inteligentes” y, quizás lo más importante, movilizar recursos humanos, financieros y recursos institucionales para propiciar una resignificación o refundación de los vínculos culturales, espirituales y afectivos de los habitantes urbanos con el bosque, apoyados en la gente del bosque y sus cosmovisiones.

Problematic Social Networking Sites Use (PSNSU) has been indicated as potentially detrimental for users' mental and sleep health. The present study tested whether PSNSU is directly associated with poor sleep quality and indirectly via psychological distress (stress, anxiety, depression) in a healthy adult sample of Social Networking Sites (SNSs) users.Cross-sectional study among Italian adults who completed online questionnaires between December 2020 and January 2021.Italy.A convenient sample of N = 726 SNSs users (51.8% females; mean age = 28.59 years, SD = 8.19 years).Self-report data were collected on problematic social networking sites use, sleep quality, psychological distress (stress, anxiety, depression), and socio-demographics.PSNSU was not directly associated with poor sleep quality. Depression and stress mediated such association.Healthcare providers should consider psychological distress and PSNSU when encountering sleep problems, with consideration of the potentially important role of users' age and mental health status.

Problematic Social Networking Sites Use (PSNSU) and social anxiety are associated. SNSs users may develop online social anxiety that may become a standalone problem. The present study aims to test the mediating role of emotion dysregulation and motives (coping, conformity, social, and enhancement) between attachment (anxiety and avoidance) and two outcomes (PSNSU and online social anxiety) in an integrated theory-driven model. Self-report questionnaires were completed by 756 SNSs users (50.4 % females; mean age = 28.74 years, SD = 8.00). Results of the path analysis supported the partial mediating role of emotion dysregulation in the association between attachment anxiety and both the outcomes and the serial mediating role via four and three motives in the association with PSNSU and online social anxiety, respectively. This study highlighted the role of several relational, emotional, and motivational factors that should be taken into account to tackle PSNSU and online social anxiety through clinical and prevention interventions.

Background: Alpha 1 antitrypsin deficiency (AATD) is an autosomal codominant genetic condition that affects Caucasians of the European population due to the presence of a deficient allele of the SERPINA1 gene. A frequency of about 1/5,000 individuals has been estimated in Italy. Objectives: The aim of the study was to evaluate the distribution of the clinical manifestations of severe and intermediate genetic AATD in the geographic area around Parma in Northern Italy. Method: 238 subjects were submitted to molecular analysis of the SERPINA1 gene, and data on anthropometric variables, smoking habits, number of packs per year, AAT serum concentration, and clinical manifestations were recorded and presented as mean ± SD or median values (1st quartile; 3rd quartile). Results: The results show a distribution of genetic AATD of 4.1% of the screened population in the area encompassing the city of Parma. PI*MS and PI*MZ were the most common genotypes at 40.9% and 28.2% of the population with genetic AATD, and asthma and emphysema were the most represented clinical manifestations. Conclusion: Our study allowed to increase the knowledge of the distribution of genetic AATD in Northern Italy providing information regarding frequencies of genotypes and clinical manifestations of the disorder.

By providing a brief and non-authoritative analysis of the physical and cultural relations between rural (forest) and urban areas in the Amazon, we identify several points for improvement, such as economic incentives to encourage healthcare professionals to serve the countryside, implementing peri-urban agricultural belts to improve urban food security, increasing access to urban green spaces, and investing in innovation around the “smart cities, smart forests” concept. Perhaps most importantly, this would include mobilizing human, financial, and institutional resources to restore cultural, spiritual, and affective bonds between urban and forest inhabitants.

The detrimental role of childhood emotional neglect (CEN) on long-term affective and social development has received increasing attention in the literature. Individuals who were emotionally neglected during their childhood are more prone to feeling isolated and excluded by their parent during adolescence. However, little is known about the mediating processes underlying this association.This study investigated whether self-other differentiation (SOD) and emotional detachment from parents mediate the link between CEN and parent-related loneliness.A sample of 535 high school students aged 13-18 years (63.6% female; MAfter controlling for demographic covariates, structural equation modeling (SEM) showed that (a) CEN was positively associated with parent-related loneliness (β = 0.64, p .001), (b) SOD did not mediate the relationship between CEN and parent-related loneliness (β = -0.01, p = .142), (c) emotional detachment partially mediated the relationship between CEN and parent-related loneliness (β = 0.16, p .001), and (d) SOD and emotional detachment partially and sequentially mediated the link between CEN and parent-related loneliness, albeit with a small effect size (β = 0.02, p = .027).The findings underscore the significance of the link between CEN and parent-related loneliness in adolescence. Moreover, our results suggest that some adolescents with a history of CEN have difficulties in establishing clear boundaries between "self" and "other" and tend to engage in emotionally detached relationships with their parents, which may lead them to feel more parent-related loneliness. Clinical implications and directions for future research are discussed.

The main objective of cardiovascular disease prevention is to reduce morbidity and mortality by promoting a healthy lifestyle, reducing risk factors, and improving adherence to medications. Secondary prevention after an acute coronary syndrome has proved to be effective in reducing new cardiovascular events, but its limited use in everyday clinical practice suggests that there is considerable room for improvement. The short-term results of evidence-based studies of nurse-coordinated secondary prevention programs have been positive, but there is a lack of long-term outcome data. The Alliance for the Secondary Prevention of Cardiovascular Disease in the Emilia-Romagna region (ALLEPRE) is a multicenter, randomized, controlled trial designed to compare the effects of a structured nurse-coordinated intensive intervention on long-term outcomes and risk profiles after an acute coronary syndrome with those of the standard of care. All of the patients randomized to the intervention group take part in 9 one-to-one sessions with an experienced nurse from the participating centers with the aim at promoting healthy lifestyles, reducing risk factors, and increasing adherence to medication over a mean period of 5 years. The primary clinical end point is the reduction in the risk of the 5-year occurrence of major adverse events (a composite of cardiovascular mortality, nonfatal reinfarction, and nonfatal stroke). The primary surrogate end point is the achievement of prespecified targets relating to classical risk factors, lifestyle modifications, and adherence to pharmacological therapy after 2 years of follow-up. Coronary heart disease is a chronic degenerative disease, and patients who recover from an acute coronary syndrome (ACS) are at high risk of developing recurrent events.1 Although secondary prevention measures have proved to be effective and are strongly recommended by all of the international guidelines,2., 3. the 4 EUROASPIRE surveys4., 5., 6., 7., 8. showed that there was still a high prevalence of conventional risk factors, that secondary prevention measures were inadequately implemented, and that their main goals were often not reached. In addition, there were considerable discrepancy in secondary prevention practices between centers and countries, and a widespread underuse of cardiac prevention and rehabilitation programs despite their demonstrated effectiveness in reducing cardiovascular risk over time.9., 10. Over the last 10 years, nurses have been increasingly involved in successful cardiovascular risk management,11., 12., 13. but although this has improved levels of cardiovascular risk, no clear reduction in hard end points such as major cardiovascular adverse events and mortality has been demonstrated.10 The aim of the ALLEPRE trial is to evaluate the benefit of a homogeneous, structured, secondary prevention intervention program, fully coordinated by nurses from in- and outpatient clinics, in terms of cardiovascular risk profiles and major clinical events in ACS patients living in the large Emilia-Romagna region of Italy.

Background The aim of the present study was to clarify the roles of cytomegalovirus (CMV), Epstein-Barr virus (EBV), and human herpesvirus 6 (HHV-6) in immunocompetent children with acute liver dysfunction not resulting from hepatitis virus. Methods Sixty-eight children (median age, 3 years) hospitalized as a result of acute liver dysfunction were enrolled in this study. Hepatitis A, B, and C were excluded. The prevalence of CMV, EBV, and HHV-6 and viral DNA load in whole blood was prospectively evaluated on multiplex real-time polymerase chain reaction (PCR). Results Of the 68 children with acute liver dysfunction, multiplex real-time PCR was positive in 30 (44%). CMV, EBV, and HHV-6 DNA were detected in 13 (19%), 14 (21%), and seven (10%), respectively. Serum CMV immunoglobulin (Ig)G/IgM and EBV viral capsid antigen IgG/IgM were measured in 40 (CMV DNA positive, n = 10; negative, n = 30) and 45 (EBV DNA positive, n = 14; negative, n = 31) of the 68 children, respectively. Eighteen percent (CMV, 7/40) and 9% (EBV, 4/45) were positive for both PCR and viral-specific IgM. There was no significant difference in CMV and EBV viral load between IgM-positive and -negative children with viremia. Conclusions CMV, EBV, and HHV-6 DNA were frequently detected in immunocompetent children with acute liver dysfunction, but primary CMV and EBV infection were confirmed in 10-20% of the children with acute liver dysfunction. The combination of PCR assay and serology is necessary to make a diagnosis of acute liver dysfunction due to primary CMV, EBV and/or HHV-6 infection in immunocompetent children.

A new lithium-ion conducting oxide, hexagonal Li4GeO4, with a space group of P63/mmc, was prepared by mechanochemical treatment and subsequent heat treatment at 250 °C. The crystal structure was found in sulfide Li4SnS4, and this is the first study to report an oxide system. In addition, (100-x)Li4GeO4·xLi2MO4 (M = S or W; x = 10, 20, 30, and 40 mol%) glass-ceramic electrolytes with the hexagonal phase were prepared by crystallization of their mother glasses. The formability of the electrolytes improved as the quantity of Li2SO4 increased, and the 90Li4GeO4·10Li2SO4 glass-ceramic electrolyte showed the highest ionic conductivity of 2.9 × 10−6 S cm−1 at 25 °C. Compared with the experimental results, the bond valence sum (BVS) analysis results indicated that ionic conduction paths are easily connected along the c-axis in the hexagonal phase, suggesting that the relatively small lattices in the a- and b-axes are more advantageous for three-dimensional ionic conduction.

To the editor: Erdheim-Chester disease (ECD) is a rare non-Langerhans cell histiocytosis (

Objectives To establish if the presence of chronic kidney disease (CKD) influences fractional flow reserve (FFR) value in patients with intermediate coronary stenosis. Background FFR-guided coronary revascularization reduces cardiac adverse events in patients with coronary artery disease. CKD impairs microcirculation and increases cardiovascular risk. Whether CKD presence may limit FFR accuracy is unknown. Methods We used data from a multicenter prospective registry enrolling 1.004 patients undergoing FFR evaluation for intermediate stenosis. We assessed the relationship between clinical and angiographic variables and FFR measurement. CKD was defined as CrCl value ≤45 ml/min. FFR value was considered potentially flow-limiting, and therefore positive, if ≤0.80. The index of microcirculatory resistance (IMR) was calculated in 20 patients stratified according CrCl value (single-center substudy). Results: FFR measurement was positive in 395 (39%) patients. Overall, 131 (13%) patients had CKD. Patients with CrCl ≤45 ml/min showed significantly higher FFR values as compared to the others (0.84 ± 0.07 vs. 0.81 ± 0.08, p

Objective To demonstrate the safety and efficacy of a new sirolimus eluting stent with bioresorbable polymer, Ultimaster, (BP-SES) compared with everolimus-eluting, permanent polymer, Xience stent (PP-EES) in bifurcation lesions with respect to the freedom from Target Lesion Failure at 1-year. Methods Within 1,119 patients enrolled in the CENTURY II randomized controlled multicenter trial, 194 patients were treated for bifurcation lesions and randomized to either BP-SES (n = 95) or PP-EES (n = 99). The primary endpoint was freedom from target lesion failure (TLF) composite endpoint [cardiac death, MI not clearly attributable to a non-target vessel, and clinically driven target lesion revascularization (TLR)] at 1-year. Results Baseline patient demographic, angiographic, and stenting characteristics were similar in both study arms. A single stent technique with provisional or “cross over” stenting were the most widely used in both arms (93.2% BP-SES vs. 92.4% PP-EES). Freedom from TLF at 1-year was 94.7% for BP-SES and 91.9% for PP-EES (P for noninferiority 0.031). The rate of clinically driven target lesion revascularization (TLR) at 1-year was 3.2% for BP-SES and 3.0% for PP-EES (P = 0.95). There were no significant differences detected in any of the individual clinical endpoints or other secondary clinical endpoints between the study arms at 1-year follow up. Conclusions The new bioresorbable polymer sirolimus-eluting stent showed safety and efficacy profiles similar to durable polymer everolimus-eluting in the treatment of patients with bifurcation lesions at 1-year follow up. © 2015 Wiley Periodicals, Inc.

AIMS Percutaneous coronary intervention (PCI) and antithrombotic drugs are the standard therapy for patients with acute coronary syndromes (ACS), but their impact on bleeding and mortality in women has not been adequately investigated. METHODS This was a prospective observational cohort study of ACS patients, who were referred to 6 of the 13 centres belonging to the REgistro regionale AngiopLastiche dell'Emilia-Romagna programme in Emilia-Romagna for coronary angiography and PCI between June 2010 and November 2011. The aim of the study was to verify whether the incidence of Global Registry of Acute Coronary Events-defined in-hospital bleeding after an ACS is significantly higher in women than in men, and to evaluate its impact on short and long-term mortality. RESULTS The analysis involved a total of 1686 patients (511 women and 1175 men). The women were older and more frequently affected by hypertension, congestive heart failure and single-vessel disease; however, none of the clinical or procedural variables was significantly different between the sexes after statistical adjustment. There was a significantly higher rate of in-hospital bleeding among the women [8.6 vs. 5.8%; adjusted odds ratio 1.73, 95% confidence interval (CI) 1.19-2.52, P = 0.004], but the adjusted hazard ratio for short and long-term all-cause mortality was not significantly different. After optimal adjustment, bleeding, but not female sex, was identified as a predictor of short-term all-cause mortality (hazard ratio 2.68, 95% CI 1.21-5.93, P = 0.01), but this was not confirmed in the case of long-term mortality (hazard ratio 1.57, 95% CI 0.91-2.71, P = 0.10). CONCLUSION After optimal adjustment for baseline differences, the findings of this contemporary Italian PCI registry study showed that women experience bleeding more frequently, but do not have worse mortality outcomes than men. Bleeding was confirmed as an independent predictor of short-term mortality.

Background Vaccination against hepatitis B virus (HBV) infection in infants born to hepatitis B surface antigen (HBsAg)-positive mothers using HB immunoglobulin (HBIG) and hepatitis B (HB) vaccine was launched in Japan in 1985. Infants testing positive for HBsAg at 1 month of age are considered to have prenatally acquired the infection and are usually excluded from the prevention program. Infants born to HB e antigen (HBeAg)-positive mothers are at a high risk of perinatally acquiring the infection. In this study, long-term outcome was evaluated in children with prenatal HBV infection who received the HBIG and HB vaccine in Japan. Methods Newborns of both HBsAg- and HBeAg-positive carrier mothers received HBIG within 48 h of birth and at 2 months of age. Subsequently, three doses of recombinant HB vaccine were given at 2, 3, and 5 months of age. Outcome was compared between the following two groups: infants who completed the vaccination program, even if they were HBsAg positive at 1 month of age (n = 15), and infants who did not (n = 51). Results Seroconversion from HBeAg to anti-HBe antibody (HBeAb) before 3 years of age was observed in five children (33%) who completed the vaccination program and in two (4%) who did not (P = 0.005). In 2/5 children who completed the vaccination program and achieved HBeAb seroconversion, seroconversion from HBsAg to anti-HBs antibody was also noted. Conclusion This specific vaccination program for children with prenatal HBV infection has the potential to alter immune tolerance to HBV.

the development of power electronics and the use of semiconductors has encouraged scientists to undertake important associations of static power converters to electrical machines. These devices are generally non-linear loads, which absorb a nonsinusoidal current and act as harmonic generators. This paper presents the study and comparison of two control strategies applied to a three-phase shunt active power filter. These two control strategies are: the conventional control based on the instantaneous powers and the control based on a fuzzy logic regulator, elaborated in the form of linguistic rules. The criterion of comparison is the total harmonic distortion and the DC bus regulation. The simulation of the system under the Matlab / Simulink environment showed that the method based on fuzzy logic gives better results.

In our previous work we proposed a modilfied protocol for simultaneous estimation of compartmental and graphical analysis kinetic parameters in whole-body (WB) dynamic PET imaging. The protocol is clinically feasible in continuous bed motion (CBM) acquisition mode. Therefore certain kinetic modelling related parameters, such as temporal frame definition and duration are selected a priori through CBM pass and bed speed selection. This is in contrast to traditional single bed dynamic imaging where such parameters are defined a posteriori. Furthermore optimum CBM parameters might vary between compartmental and graphical analysis. To this end a joint optimization of acquisition and kinetic modelling parameters is attempted. Using the XCAT phantom as well as clinical studies, the impact of temporal frame definition, frame duration and total scan duration on micro-and macro-parametric images is evaluated, through modulation of CBM parameters such as the bed speed and number of passes. Furthermore for Patlak graphical analysis and compartmental modelling, the optimum regression window was systematically investigated with respect to the selected CBM parameters.

The use of renewable energies has grown significantly in the world. Given the growing demand for electrical energy. In this paper we discuss the optimization of the production of a GPV by two different techniques MPPT.In order to make a full operation of photovoltaic array, its compulsory to inaugurate a protocol or an algorithm to help extract, track and maximize the available power, this technique is called Maximum Power Point Tracking (MPPT).A several number of technique has been presented, such as the classic techniques; Perturb and Observe (P&O) [1], and incremental conductance [2], which are largely used mostly due to their simplicity of implementation and less complexity.In this paper, a Fuzzy Logic Controller (FLC) based MPPT technique [3] is compared to conventional P&O technique. The simulation in MATLAB/Simulink environment reveals the superior performance of FLC based technique over P&O method.

Uma das intervencoes antropicas que ocorre no Brasil, principalmente no Estado do Mato Grosso do Sul, e a expansao do cultivo de monoculturas, mais precisamente de eucalipto, gerando assim, diversas preocupacoes que influencia nos ambientes naturais. Diante desta premissa, o presente trabalho tem como objetivo identificar as alteracoes no uso e cobertura da terra em decorrencia da expansao do cultivo de eucalipto no municipio de Inocencia/MS, situado na regiao leste do Estado de Mato Grosso do Sul, nos anos de 2000, 2008 e 2014. Para a analise, utilizou-se das imagens do satelite LandSat 5, sensor TM e do satelite LandSat 8, sensor OLI, para compreender a evolucao do processo de uso e cobertura da terra, com auxilio dos programas Spring® e ArcGis®. Os resultados indicaram que a area de pastagem e predominante em todos os anos, o que colabora com a diminuicao de areas florestais. O cultivo de eucalipto esta crescendo na regiao, devido ao aumento das terras de florestas plantadas responsaveis pelas empresas Fibria-MS Celulose Ltda; e Investimentos Florestais S/A – Eldorado Brasil, substituindo as areas de pastagens e ate mesmo areas de lavouras. Pode-se concluir que as informacoes obtidas pelos mapeamentos do uso e cobertura da terra evidenciaram a expansao do cultivo de eucalipto e foram classificadas as formas de uso de acordo com a acao antropica. Portanto possibilitou a caracterizacao da area, que vem passando por rapidas transformacoes em seu uso e cobertura da terra, efetivando a necessidade de mais pesquisas voltadas para esta analise. PALAVRAS CHAVE: Cultivo de eucalipto. Sensoriamento Remoto. Uso e Cobertura da Terra.

Os processos de degradacao em bacias hidrograficas estabelecem graves dificuldades em escala mundial, com implicacoes ambientais, sociais e economicas expressivas, sendo necessarias pesquisas que analisem as caracteristicas do relevo que acabam influenciando diretamente nos processos erosivos, permitindo uma melhor gestao das praticas desenvolvidas nas bacias hidrograficas. O objetivo dessa pesquisa e avaliar a energia potencial erosiva do relevo, por meio da interacao da declividade, dissecacao horizontal e vertical da Bacia Hidrografica do Corrego Moeda - BHCM, Tres Lagoas/MS. Foram realizados mapeamentos em ambiente SIG, bem como, demarcados onze pontos ao longo da bacia. Com os resultados obtidos, apontou-se um relevo plano a suave, com declives de 0 a 6%, ja oferecendo limitacoes de ocupacao rural, necessitando de acoes de controle erosivo. O comprimento das vertentes apontaram a maior presenca das classes de 100 a 500 metros (horizontal) e das classes de 0 a 50 metros (vertical). Com isso, apresentou-se como maior classe, a Energia Potencial Erosiva do Relevo Fraca, ficando disposta ao longo da BHCM. De maneira geral, o mapeamento ofereceu informacoes capazes de confirmar a influencia das declividades sobre o potencial erosivo, pois seus indices ficaram mais elevados nos locais onde os declives sao mais acentuados, nao ocorrendo da mesma forma com as dissecacoes. Normal 0 21 false false false PT-BR X-NONE X-NONE /* Style Definitions */ table.MsoNormalTable {mso-style-name:"Tabela normal"; mso-tstyle-rowband-size:0; mso-tstyle-colband-size:0; mso-style-noshow:yes; mso-style-priority:99; mso-style-qformat:yes; mso-style-parent:""; mso-padding-alt:0cm 5.4pt 0cm 5.4pt; mso-para-margin:0cm; mso-para-margin-bottom:.0001pt; mso-pagination:widow-orphan; font-size:11.0pt; font-family:"Calibri","sans-serif"; mso-ascii-font-family:Calibri; mso-ascii-theme-font:minor-latin; mso-fareast-font-family:"Times New Roman"; mso-fareast-theme-font:minor-fareast; mso-hansi-font-family:Calibri; mso-hansi-theme-font:minor-latin; mso-bidi-font-family:"Times New Roman"; mso-bidi-theme-font:minor-bidi;}

Objectives The aim of this study was to compare long-term clinical outcomes in patients treated with new-generation drug-eluting stent (DES) or early-generation DES in a real-world registry. Background New-generation DESs have proved to be more effective and safer than early-generation DES in randomized trials. However, the effects of new-generation DES versus early-generation DES in everyday clinical practice deserve further verification. Methods A propensity-score and inverse-probability weighted analysis of 5,332 patients undergoing DES implantation (2,557 new-generation and 2,775 early-generation) between January 1, 2007 and June 30, 2011 was performed, with a median follow-up of 3 years. We assessed the incidence of major adverse cardiovascular events (MACE: all-cause death, nonfatal myocardial infarction [MI], and target vessel revascularization [TVR]), and angiographic stent thrombosis (ST) during follow-up. Results At 3-years, new-generation DES in comparison with early-generation DES were associated with a reduced risk of MI (5% versus 7.4%, hazard ratio [HR] = 0.65, 95% confidence interval [CI] = 0.51–0.82, P = 0.0004) and angiographic ST (0.5% vs. 1.1%, HR = 0.35, 95% CI 0.17–0.72, P = 0.004), whereas, the risk of TVR (10.9% vs. 13.5%; HR 0.99, 95% CI 0.84–1.16, P = 0.99) and overall MACE was not significantly different (19.2% vs. 22.4%, HR = 0.94, 95% CI = 0.83–1.07, P = 0.35). Conclusions Our data from a large all-comers multicenter registry confirm that, in comparison with early-generation DES, the use of new-generation DES is associated with similar efficacy and increased long-term safety, because of a reduced risk of ST and MI. © 2014 Wiley Periodicals, Inc.

Although neonatal hemochromatosis (NH) is a well-known cause of liver failure during the neonatal period and iron deposition in extrahepatic tissues is considered essential in the diagnosis of NH, there is no consensus regarding the pathology or diagnostic criteria of NH. Recent studies of immunohistochemical assays have shown that the C5b-9 complex (the terminal membrane attack complement complex) is strongly expressed in the liver of NH cases, suggesting that a gestational alloimmune mechanism is the cause of liver injury. The patient was a low birthweight primiparous male born at 37 weeks of gestation by vaginal delivery. Blood tests 3 h after birth showed signs of liver failure, including high transferrin saturation, resembling the clinical characteristics of NH. However, magnetic resonance imaging and a lip biopsy showed no obvious iron deposition outside the liver. The patient was refractory to exchange transfusion and immunoglobulin therapy but was successfully treated by liver transplantation. Histologically, the explanted liver showed established cirrhosis, with large amounts of human C5b-9 in the residual hepatocytes, suggesting the alloimmune mechanism of liver injury was the cause of his liver failure. Liver failure caused by a gestational alloimmune mechanism should be considered in patients with antenatal liver failure, even without obvious extrahepatic siderosis.

Background The concept of a single-lead dual-chamber implantable cardioverter defibrillator (ICD) with floating sensing atrial dipole has been proven safe and functional. We report a single-center experience with this ICD system; the major focus of the work is on the recorded atrial activation and its stability on a medium term follow-up. Methods Thirteen patients received a DX ICD (BIOTRONIK SE & Co, Berlin, Germany) with the Linox Smart S DXProMRI ICD lead; the implantation data were reported. Daily P- and R-wave sensing amplitude was collected and followed up during 200 days; their coefficient of variance (CV) was calculated. In addition, all the atrial and ventricular high-rate episodes were analyzed. Results The total x-ray exposure time was 3.9 ± 1.8 minutes. The overall mean sensing was 4.2 ± 1.9 mV for P wave and 12.9 ± 4.5 mV for R wave. The CV was significantly higher for the P-wave amplitude than for the R-wave one (0.25 ± 0.11 vs 0.08 ± 0.06; P < 0.001). A total of 27 high ventricular rate episodes were recorded and correctly discriminated by the device. Fifty-six high atrial rate episodes were recorded, 49 were true arrhythmic events. Conclusions The single-lead ICD system with floating atrial dipole provides reliable atrial sensing amplitude over time. The physician, without the implantation of an additional lead, has the atrial information that may be used for the discrimination of supraventricular tachyarrhythmia/ventricular tachycardia, for the early detection of atrial fibrillation episodes and for the evaluation of changes in the patient's heart status.

We describe herein a chiral phosphoric acid catalyzed Friedel–Crafts reaction of indoles with β-alkoxycarbonyl-β-disubstituted nitroalkenes. A wide variety of substrates participated in this reaction to afford indoles having all-carbon quaternary centers with excellent selectivities (up to 97% ee). Further investigation suggested that the olefin geometry and the employment of NH-indole derivatives are responsible for both reactivity and selectivity.

Novel nitride glass electrolyte Li 3 BN 2 was prepared from Li 3 N and BN via a mechanochemical process using planetary ball milling. Raman and X-ray photoelectron spectroscopies revealed that the glass was composed of Li + and BN 2 3− ions. The Li 3 BN 2 glass exhibited good ductility, and the powder-compressed pellet showed a relative density of 84%. The hot-pressed pellet of the Li 3 BN 2 glass showed a conductivity of 1.3 × 10 −5 S cm −1 at 25 °C, which is much higher than that of oxide-based glass electrolytes such as Li 3 BO 3 glass and LiPON thin films. Moreover, Young's modulus of the Li 3 BN 2 glass was 51.1 GPa, which is an intermediate value between sulfides and oxides. The Li symmetric cell using the Li 3 BN 2 glass electrolyte was cycled stably at 100 °C without short-circuiting. Nitride glassy materials are promising electrolytes for all-solid-state batteries because of their high conductivity, good mechanical properties, and electrochemical stability.

Aim The relationship between pegylated interferon (PEG IFN)-α-2a and growth of children with chronic hepatitis C (CHC) remains unclear. This study was to evaluate the effects of PEG IFN-α-2a on growth. Methods From 2003–2012, we prospectively analyzed the data of children with CHC through mother-to-infant transmission. They were all treatment naive and were treated with PEG IFN-α-2a monotherapy. Results Among 31 children (19 boys, 12 girls; median age, 6 years) treated with monotherapy during the study period, 21 children (13 boys, eight girls; median age, 7 years) were statistically analyzed. The median treatment period of the 21 children was 48 weeks (range, 48–72). Z-scores of height and weight before treatment, at the end of treatment and 1 year after treatment were −0.05, −0.24 and −0.12 (height), and +0.11, −0.23 and −0.05 (weight). Both Z-scores were significantly decreased at the end of the treatment. One year after treatment, Z-scores of height and bodyweight were significantly improved compared with that of end of treatment but were still lower than those before treatment, with statistical significance. Z-scores of height growth velocity was significantly increased after the treatment (+0.71), compared with that during treatment (−2.25). Conclusion PEG IFN-α-2a has an inhibitory effect on children's growth, and Z-scores of height and bodyweight were decreased at the end of treatment. Although Z-scores improved after the treatment, they had not returned to the baseline level 1 year after the treatment.

A analise da qualidade das aguas superficiais e utilizada como uma das principais analises, que determinam possiveis modificacoes no equilibrio de uma bacia hidrografica, dessa forma, e extremamente necessaria sua identificacao, bem como, os pontos em que estao ocorrendo anomalias que acabam resultando em um enquadramento em classes mais altas segundo as resolucoes do CONAMA. Com isso, esta pesquisa tem como objetivo, analisar a qualidade das aguas superficiais da bacia hidrografica do corrego Moeda, mediante a afericao do oxigenio dissolvido, pH, turbidez, temperatura do ar e agua e condutividade eletrica. Para isso, serao utilizadas as resolucoes do CONAMA 357/2005 e 430/2011, fornecendo importantes informacoes a cerca dos recursos hidricos desta bacia hidrografica. O equipamento utilizado para a analise destes parâmetros e o Horiba U-50 Series Multiparameter water Quality Unit’s. Os resultados apontaram para um enquadramento na classe IV nos pontos 8 e 11, devido principalmente a falta de mata ciliar e ao represamento das aguas, respectivamente, que acabam ocasionando na reducao do OD. Outro local que merece destaque e ponto 1, que ficou enquadrado na classe III, devido a sua alta condutividade eletrica e baixo OD, principalmente por seu um local onde o gado adentra ate suas aguas, modificando o equilibrio deste ambiente aquatico. No geral a BHCM ficou enquadrada na classe II, preconizando sua utilizacao para o abastecimento humano desde que haja um tratamento convencional. PALAVRAS-CHAVE: Bacia Hidrografica. Qualidade das Aguas Superficiais. Enquadramento.

O presente trabalho e fruto de pesquisas realizadas no laboratorio de planejamento e gestao de recursos hidricos (LaPGRH) da Universidade Federal do Mato Grosso do Sul, a qual faz parte de uma dissertacao de mestrado. O objetivo deste artigo e analisar a dissecacao horizontal e vertical baseadas na metodologia de Spiridonov (1981) com adaptacoes, levando em consideracao os prolongamentos dos canais perenes, intermitente e efemeros, auxiliando, assim, por meio da analise do comprimento e altitude das rampas, na compreensao da acao dos mananciais hidricos na compartimentacao do relevo na Bacia Hidrografica do Corrego Moeda, Tres Lagoas/MS. Os resultados mostraram que parte consideravel da bacia apresenta potencial erosivo significativo, necessitando de cuidados e manejo adequado, bem como a preservacao da vegetacao nessas referidas areas, a qual possibilita a diminuicao da velocidade do fluxo de agua e cujas raizes agregam o solo e contribuem para que a quantidade de sedimentos carreados para os corregos e o surgimento de sulcos e ravinas sejam minimizados. PALAVRAS-CHAVE: Bacia Hidrografica, Dissecacao Vertical e Horizontal, Processos Erosivos. Analysis of the Horizontal and Vertical Dissection of the Hydrographic Basin of the Stream Moeda, Tres Lagoas/MS ABSTRACT: This work is the result of research conducted in laboratory planning and management of water resources (UPGRH) of the Federal University of Mato Grosso do Sul, which is part of a master dissertation. The purpose of this article is to analyze the horizontal and vertical dissection based on Spiridonov methodology (1981) with adaptations, assuming extensions of the perennial, intermittent and ephemeral channels, thereby aiding, for analyzing the length and height of ramps, in understanding the action of water sources in the partitioning of the relief in the Hydrographic Basin Stream Moeda, Tres Lagoas/MS. The results showed that a considerable part of the basin has significant erosive potential, needing care and proper management and preservation of vegetation in these areas mentioned, which enables the reduction in water flow velocity whose roots aggregate the soil and contribute to the amount of carried sediments into streams and the appearance of ridges and gullies are minimized. KEY WORDS : Hydrographic basin, Dissection Vertical and Horizontal, processes erosives. Analisis de la Diseccion Horizontal y Vertical de la Cuenca Hidrografica Arroyo Moeda, Tres Lagoas/MS RESUMEN: Este trabajo es el resultado de las investigaciones realizadas en el laboratorio de planificacion y gestion de los recursos hidricos (LaPGRH) de la Universidad Federal de Mato Grosso do Sul, que es parte de una tesis de maestria. El proposito de este articulo es analizar la diseccion horizontal y vertical basado en la metodologia Spiridonov (1981), con adaptaciones, teniendo en cuenta las proyecciones de los canales perennes, intermitentes y efimeros, ayudando asi a traves del analisis de la longitud y la altura de las rampas, en la comprension de la accion de las fuentes de agua en la compartimentacion de alivio en la Cuenca del Arroyo Moeda, Tres Lagoas/MS. Los resultados mostraron que una parte considerable de la cuenca tiene un importante potencial erosivo en necesidad de cuidado y manejo adecuado, asi como la preservacion de la vegetacion de estas zonas mencionadas, lo que permite la reduccion de la velocidad del flujo de agua y cuyas raices anadir el suelo y contribuir a la cantidad de sedimentos transportados en corrientes y la aparicion de crestas y barrancos se reducen al minimo. PALABRAS CLAVE: Cuenca Hidrografica, Diseccion Vertical y Horizontal, Procesos Erosivos.

O potencial do relevo exerce forca sobre as aguas fluviais, influenciando na sua velocidade, vazao e capacidade de dissecacao, transporte e deposicao de sedimentos. Dessa forma, esta pesquisa tem como objetivo, analisar a energia potencial erosiva pluviometrica da bacia hidrografica do corrego Moeda, localizada no municipio de Tres Lagoas/MS. Esta analise se baseara na metodologia de Bertoni e Lombardi Neto (1999) que consiste em calcular o potencial erosivo de acordo com as precipitacoes, sendo utilizados calculos matematicos e espacializando os indices encontrados, ao longo das estacoes do ano de 2014. Os resultados obtidos apontaram que os maiores potenciais erosivos pluviometrico se encontram no verao e na primavera, sendo encontrado os maiores indices nas proximidades da nascente do corrego Moeda, o ponto 1 de monitoramento. Alem dos altos valores encontrados no verao e na primavera, a energia da precipitacao acabou variando conforme as estacoes do ano, mostrando a importância de continuar o moitoramento, pois esse potencial vem causando modificacoes aos recursos hidricos desta bacia. Para que reduza estas modificacoes, foram propostas algumas sugestoes visando um equilibrio maior desta importante bacia hidrografica. PALAVRAS-CHAVE: Energia Potencial Erosiva Pluviometrica. Precipitacao. Bacia Hidrografica. Recursos Hidricos. Energy Potential Erosive Rain Gauge of the Hydrographic Basin Stream Moeda, Tres Lagoas/MS ABSTRACT The relief potential exerts force on the river water, influencing its speed, flow and dissection, transportation and deposition of sediment. Thus, this research aims to analyze the rainfall erosive potential energy of the hydrographic basin stream Moeda, located in the municipality of Tres Lagoas / MS. This analysis will be based on the methodology Bertoni and Lombardi Neto (1999), which is to calculate the erosive potential according to rainfall, and used mathematical calculations and spatialising indexes found, throughout the seasons of the year 2014. The results showed that the greatest potential erosive rainfall are in the summer and spring, and found the highest rates near stream source of currency, point 1 monitoring. In addition to the high values found in the summer and spring, the energy of rainfall over varying according to the seasons, showing the importance of continuing the moitoramento because this potential is causing changes to the water resources of the basin. To reduce these changes were proposed some suggestions for a better balance of this important watershed. KEYWORDS: Energy Potential Erosive Rain gauge. Precipitation. Hydrographic basin. Water resources. Energia Potencial Erosivo Pluviometro de la Cuenca Hidrografica Del Arroyo Moeda, Tres Lagoas/MS RESUMEN El potencial de alivio ejerce una fuerza sobre el agua del rio, que influyen en su velocidad, el flujo y la diseccion, transporte y deposicion de sedimentos. Por lo tanto, la presente investigacion tiene como objetivo analizar la energia potencial erosivo precipitacionesde la cuenca hidrografica delarroyoMoeda,situada en el municipio de Tres Lagoas / MS. Este analisis se basa en la metodologia Bertoni y Lombardi Neto (1999), que consiste en calcular el potencial erosivo segun las precipitaciones, y se utiliza calculos matematicos e indices spatialising encontrado, a lo largo de las estaciones del ano 2014. Los resultados mostraron que la mayor precipitacion erosiva potencial son en el verano y la primavera, y encontraron las tasas mas altas cerca de la fuente de arroyo Moeda, el punto 1 de vigilancia. Ademas de los altos valores que se encuentran en el verano y la primavera, la energia de las precipitaciones sobre variando de acuerdo a las estaciones del ano, mostrando la importancia de continuar el moitoramento porque este potencial esta causando cambios en los recursos hidricos de la cuenca. Para reducir estos cambios se propusieron algunas sugerencias para un mejor equilibrio de esta importante cuenca. PALABRAS CLAVE: Energia potencial erosivo pluviometro. Precipitacion. Cuenca hidrografica. Recursos hidricos.

Background The aim of this study was to compare 7-year rates of all-cause death, cardiac death, myocardial infarction, target vessel revascularization, and stroke in a large cohort of octogenarians with left main coronary artery or multivessel disease, treated with coronary artery bypass grafting or percutaneous coronary intervention. Methods Two propensity score-matched cohorts of patients undergoing revascularization procedures at regional public and private centers of Emilia-Romagna, Italy, from July 2002 to December 2008 were used to compare long-term outcomes of percutaneous coronary intervention (947 patients) and coronary artery bypass grafting (441 patients). Results There were no significant differences between groups in 30-day mortality. In the follow-up the overall and the matched percutaneous coronary intervention population experienced significantly worse outcomes in terms of cardiac mortality, myocardial infarction, and target vessel revascularization. No difference was found for stroke between treatment groups. Percutaneous coronary intervention was an independent predictor of increased death at long-term follow-up. The subgroups in which coronary artery bypass grafting reduced more clearly the risk of death were age 80 to 85 years, previous myocardial infarction, history of cardiac heart failure, chronic renal failure, peripheral vascular disease, and patients with three-vessel disease associated with the left main coronary artery. Conclusions In this real-world setting, surgical coronary revascularization remains the standard of care for patients with left main or multivessel disease. The long-term outcomes of current percutaneous coronary intervention technology in octogenarians are yet to be determined with adequately powered prospective randomized studies. © 2015 The Society of Thoracic Surgeons.

Objectives To assess the feasibility and safety of same day regimen of low-volume polyethylene glycol solution with ascorbic acid for bowel cleansing before colonoscopy in children. Methods The data on children who received polyethylene glycol solution with ascorbic acid for bowel cleansing in our department were retrospectively analyzed. On the day before the procedure, patients ate a low-residue diet and received sodium picosulfate in the evening. The following day patients took polyethylene glycol solution with ascorbic acid in the morning; the procedure was performed in the afternoon. Dosages of sodium picosulfate and polyethylene glycol solution with ascorbic acid were adjusted based on body weight. Bowel cleansing efficacy was rated on a scale of 1–5 by the colonoscopist. Results Between July 2013 and November 2014, polyethylene glycol solution with ascorbic acid was used in 112 cases (96 patients; male:female 73:39; median age 10.9 years old, range 4 – 19 years). 91 cases (81%) were able to orally ingest the prescribed amount of polyethylene glycol solution with ascorbic acid. Satisfactory bowel cleansing (cleansing grade ≥3) was attained in 87% on intention to treat analysis and 85% on per protocol analysis. Cleansing grade was significantly better in children ingested polyethylene glycol solution with ascorbic acid within 60 minutes (P < 0.05). There were no serious adverse events. Conclusion Same day regimen of polyethylene glycol solution with ascorbic acid is effective and safe for bowel cleansing in children. This article is protected by copyright. All rights reserved.

BACKGROUND Endodontically treated teeth are widely considered to be more susceptible to fracture than vital teeth. Obturation procedures and post placement have been a main cause of vertical root fracture. MATERIAL AND METHODS Forty-eight human premolars with standardized weakened roots were endodontically treated and allocated to four experimental groups (n=12). After root canal treatment, in group 1, fiber posts #1 were cemented in root canals using Estelite Core Quick, and the crowns were restored with resin composite. For group 2 and 3, the roots and crowns were restored using a light-cured and self-cured adhesive and resin composites respectively. In group 4, it was used the Panavia F 2.0 resin cement and resin composite for corono-radicular reconstruction. In group 5, the teeth remained untouched. After 24 hours storage and 1000 thermocycles, samples were loaded at a cross head speed of 1 mm per minute. RESULTS A significant difference was observed in fracture resistance among groups 4 and 5 compared to other groups. CONCLUSIONS Root reconstruction with fiber post and Panavia resin cement, and crown building using light-cured resin composite resulted in increased fracture resistance equal to that of intact teeth. Key words:Fracture resistance, fiber post, resin cement, resin composite.

larization), compared with 29% (23% revascularization) in the IC group. The primary outcome occurred in 43 patients (27.9%) in the EA group and 55 (34.6%) in the IC group (hazard ratio [HR]: 0.80; 95% confidence interval [CI]: 0.53 to 1.19; p 0.26). The rates of mortality (HR: 0.87; 95% CI: 0.49 to 1.56), myocardial infarction (HR: 0.67; 95% CI: 0.33 to 1.36), and repeat hospital stay (HR: 0.81; 95% CI: 0.45 to 1.46) did not differ between groups. The primary endpoint was significantly reduced in patients with elevated troponin on admission (HR: 0.43; 95% CI: 0.23 to 0.80), but not in those with normal troponin (HR: 1.67; 95% CI: 0.75 to 3.70; p for interaction 0.03). Conclusions The present study does not allow a definite conclusion about the benefit of an EA approach when applied systematically among elderly patients with NSTEACS. The finding of a significant interaction for the treatment effect according to troponin status at baseline should be confirmed in a larger size trial. (Italian Elderly ACS Study; NCT00510185) (J Am Coll Cardiol Intv 2012;5: 906 –16) © 2012 by the American College of Cardiology Foundation

Current recommendations for the antithrombotic management of patients receiving oral anticoagulation (OAC) who undergo percutaneous coronary intervention with stent implantation (PCI-S) are based on limited and relatively weak data. To broaden and strengthen available evidence, the management and 1-year outcomes of OAC patients who underwent PCI-S and were included in a prospective, multicenter registry from 2003 to 2007 were evaluated. Among the 632 patients receiving OAC, mostly because of atrial fibrillation (58%), who underwent PCI-S, mostly because of acute coronary syndromes (63%), dual-antiplatelet therapy with aspirin and clopidogrel was the most frequently prescribed at discharge (48%), followed by triple therapy with OAC, aspirin, and clopidogrel (32%) and OAC plus aspirin (18%). The choice of antithrombotic therapy largely matched the thromboembolic risk profiles of patients, with the prescription of regimens including OAC predicted by the presence of non-low-risk features. The cumulative 1-year occurrence of major adverse cardiovascular events was as high as 27% and was not significantly different among the 3 treatment groups. Stroke and stent thrombosis were limited to 2% and 3%, respectively, and although no significant differences were found among the 3 groups, stroke was 4 times less frequent when OAC, with either 1 or 2 antiplatelet agents, was administered. Major bleeding was also limited to 3%, with no significant differences among the 3 groups. In conclusion, these findings suggest overall real-world management of OAC patients who undergo PCI-S that is in accordance with their clinical risk profiles and give further support to the reported efficacy and safety of triple therapy for the optimal treatment of these patients.

Objectives This study sought to assess whether transradial intervention, by minimizing access-site bleeding and vascular events, improves outcomes in patients with ST-segment elevation myocardial infarction compared with the transfemoral approach. Background Bleeding and consequent blood product transfusions have been causally associated with a higher mortality rate in patients with myocardial infarction undergoing coronary angioplasty. Methods We identified all adults undergoing percutaneous intervention for acute myocardial infarction in Emilia-Romagna, a region in the north of Italy of 4 million residents, between January 1, 2003, and July 30, 2009, at 12 referral hospitals using a region-mandated database of percutaneous coronary intervention procedures. Differences in the risk of death at 2 years between patients undergoing transfemoral versus transradial intervention, assessed on an intention-to-treat basis, were determined from vital statistics records and compared based on propensity score adjustment and matching. Results A total of 11,068 patients were treated for acute myocardial infarction (8,000 via transfemoral and 3,068 via transradial route). According to analysis of matched pairs, the 2-year, risk-adjusted mortality rates were lower for the transradial than for the transfemoral group (8.8% vs. 11.4%; p = 0.0250). The rate of vascular complications requiring surgery or need for blood transfusion were also significantly decreased in the transradial group (1.1% vs. 2.5%, p = 0.0052). Conclusions In patients undergoing angioplasty for acute myocardial infarction, transradial treatment is associated with decreased 2-year mortality rates and a reduction in the need for vascular surgery and/or blood transfusion compared with transfemoral intervention.